NICE has issued final draft guidance that rejects the use of Celgene’s next generation multiple myeloma pill Imnovid (pomalidomide) because it is too expensive.
The watchdog was looking at the drug in a late-stage setting, and in combination with the steroid dexamethasone, after the failure of a number of other medicines for the disease on what is a complicated patient treatment pathway.
NICE currently recommends Celgene’s Thalidimod (thalidomide) for most patients as a first-line treatment, and Takeda’s Velcade (bortezomib) for people who are unable to take Thalidimod and also as an option after the first treatment has stopped working.
Meanwhile for people who have received two prior treatments NICE also recommends Revlimid (lenalidomide), another multiple myeloma (MM) medicine from Celgene.
Imnovid is the next generation version of both Thalidimod and Revlimid and this appraisal considers the use of the drug for treating MM after a third or subsequent relapse.
Celgene was hoping to gain a third yes for its new medicine, but NICE, in line with its previous draft guidance, is not recommending it be paid for by England’s NHS.
Sir Andrew Dillon, NICE’s chief executive, explained: “NICE has already recommended a number of treatment options for multiple myeloma – thalidomide, bortezomib and lenalidomide – which can greatly improve the length of time someone can live with the disease and their quality of life.
“Unfortunately we cannot recommend pomalidomide as the analyses from Celgene […] shows that the drug does not offer enough benefit to justify its high price.”
NICE says the final draft guidance is now with consultees – including Celgene and cancer charities – who have the opportunity to appeal against it. This means that Celgene now has just one final shot at getting its drug recommended before a final decision is published next month, although it is unlikely NICE will change its mind.
The list price of a pack of 21 tablets costs just under £9,000 – NICE say that this equals a QALY (Quality Adjusted Life Year) of more than £50,000. The pricing body will not usually recommend a medicine with a QALY higher than £20,000 – £30,000.
Celgene says its drug could treat a patient population of 669 in England. Multiple myeloma is the second most common blood cancer and affects around 9,900 people in the UK and Ireland.
The disease causes plasma cells to replicate uncontrollably and accumulate in the bone marrow, disrupting the production of normal blood cells. Nearly all patients diagnosed with multiple myeloma will eventually relapse and require treatment with an alternative therapy.